中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
11期
1242-1246
,共5页
宋景春%胡敦重%王涛%陈自力%林兆奋
宋景春%鬍敦重%王濤%陳自力%林兆奮
송경춘%호돈중%왕도%진자력%림조강
脓毒症%弥漫性血管内凝血%金属蛋白酶组织抑制剂
膿毒癥%瀰漫性血管內凝血%金屬蛋白酶組織抑製劑
농독증%미만성혈관내응혈%금속단백매조직억제제
Severe sepsis%Disseminated intravascular coagulation%Tissue inhibitor of metalloproteinase
目的 检测脓毒症及合并弥漫性血管内凝血(DIC)患者血清金属蛋白酶组织抑制剂(tissue inhibitor of metalloproteinase,TIMP)水平,并判断其对脓毒症患者发展成为DIC的预测诊断价值.方法 取60名患者,其中严重脓毒症患者28例(SS组),脓毒症合并DIC患者12例(SSD组),同期门诊体检者20例为对照组,收集临床及实验室参数,计算APACHEⅡ评分和DIC评分,采用酶联免疫吸附(ELISA)方法检测血清TIMP-1和TIMP-2的水平.结果 SS组患者血清TIMP-1水平(723.74±96.27)较对照组(574.24±79.99)明显升高(P＜0.05),TIMP-2水平(68.08±14.87)较对照组(89.99±18.45)明显降低(P＜0.05).SSD组患者血清TIMP-1水平(907.56±200.20)则较SS组升高明显(P＜0.05),而TIMP-2水平(44.84±22.13)也较SS组降低更明显(P＜0.05).相关分析显示TIMP-1主要与纤维蛋白原(FIB)呈负相关,差异具有统计学意义(P＜0.05),而与D-二聚体呈正相关,差异具有统计学意义(P＜0.05)；血清TIMP-2则与血小板计数(PLT)、降钙素原(PCT)、DIC评分呈负相关,差异具有统计学意义(P＜0.05).ROC曲线图显示TIMP-1/TIMP-2的AUC=0.896,95％CI:0.843～0.950 (P＜0.05),较TIMP-1或TIMP-2的AUC更高.结论 脓毒症合并DIC患者的血清TIMP-1水平明显升高,主要影响纤溶系统；TIMP-2水平明显下降,主要影响血小板功能；TIMP-1/TIMP-2对脓毒症合并DIC的发生具有诊断价值.
目的 檢測膿毒癥及閤併瀰漫性血管內凝血(DIC)患者血清金屬蛋白酶組織抑製劑(tissue inhibitor of metalloproteinase,TIMP)水平,併判斷其對膿毒癥患者髮展成為DIC的預測診斷價值.方法 取60名患者,其中嚴重膿毒癥患者28例(SS組),膿毒癥閤併DIC患者12例(SSD組),同期門診體檢者20例為對照組,收集臨床及實驗室參數,計算APACHEⅡ評分和DIC評分,採用酶聯免疫吸附(ELISA)方法檢測血清TIMP-1和TIMP-2的水平.結果 SS組患者血清TIMP-1水平(723.74±96.27)較對照組(574.24±79.99)明顯升高(P＜0.05),TIMP-2水平(68.08±14.87)較對照組(89.99±18.45)明顯降低(P＜0.05).SSD組患者血清TIMP-1水平(907.56±200.20)則較SS組升高明顯(P＜0.05),而TIMP-2水平(44.84±22.13)也較SS組降低更明顯(P＜0.05).相關分析顯示TIMP-1主要與纖維蛋白原(FIB)呈負相關,差異具有統計學意義(P＜0.05),而與D-二聚體呈正相關,差異具有統計學意義(P＜0.05)；血清TIMP-2則與血小闆計數(PLT)、降鈣素原(PCT)、DIC評分呈負相關,差異具有統計學意義(P＜0.05).ROC麯線圖顯示TIMP-1/TIMP-2的AUC=0.896,95％CI:0.843～0.950 (P＜0.05),較TIMP-1或TIMP-2的AUC更高.結論 膿毒癥閤併DIC患者的血清TIMP-1水平明顯升高,主要影響纖溶繫統；TIMP-2水平明顯下降,主要影響血小闆功能；TIMP-1/TIMP-2對膿毒癥閤併DIC的髮生具有診斷價值.
목적 검측농독증급합병미만성혈관내응혈(DIC)환자혈청금속단백매조직억제제(tissue inhibitor of metalloproteinase,TIMP)수평,병판단기대농독증환자발전성위DIC적예측진단개치.방법 취60명환자,기중엄중농독증환자28례(SS조),농독증합병DIC환자12례(SSD조),동기문진체검자20례위대조조,수집림상급실험실삼수,계산APACHEⅡ평분화DIC평분,채용매련면역흡부(ELISA)방법검측혈청TIMP-1화TIMP-2적수평.결과 SS조환자혈청TIMP-1수평(723.74±96.27)교대조조(574.24±79.99)명현승고(P＜0.05),TIMP-2수평(68.08±14.87)교대조조(89.99±18.45)명현강저(P＜0.05).SSD조환자혈청TIMP-1수평(907.56±200.20)칙교SS조승고명현(P＜0.05),이TIMP-2수평(44.84±22.13)야교SS조강저경명현(P＜0.05).상관분석현시TIMP-1주요여섬유단백원(FIB)정부상관,차이구유통계학의의(P＜0.05),이여D-이취체정정상관,차이구유통계학의의(P＜0.05)；혈청TIMP-2칙여혈소판계수(PLT)、강개소원(PCT)、DIC평분정부상관,차이구유통계학의의(P＜0.05).ROC곡선도현시TIMP-1/TIMP-2적AUC=0.896,95％CI:0.843～0.950 (P＜0.05),교TIMP-1혹TIMP-2적AUC경고.결론 농독증합병DIC환자적혈청TIMP-1수평명현승고,주요영향섬용계통；TIMP-2수평명현하강,주요영향혈소판공능；TIMP-1/TIMP-2대농독증합병DIC적발생구유진단개치.
Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation (DIC) and evaluate its diagnostic value in severe sepsis with DIC.Methods Sixty patients were divided into 3 groups,namely severe sepsis group (SS group,n =28),severe sepsis with DIC group (SSD group,n =12) and normal group (n =20).Clinical data including APACHE Ⅱ score and DIC score of these patients were collected.Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA.Results The patients of SS group had higher levels of TIMP-1 (723.74 ± 96.27) and lower levels of TIMP-2 (68.08 ± 14.87) than healthy control subjects (TIMP-1:574.24 ± 79.99,TIMP-2:89.99 ± 18.45) (P ＜ 0.05).The patients of SSD group had higher levels of TIMP-1 (907.56 ± 200.20) and lower levels of TIMP-2 (44.84 ± 22.13) than patients of SS group (P ＜ 0.05).An association was found between TIMP-1 and fibrinogen (FIB) (r =-0.392,P ＜ 0.05),TIMP-1 and D-dimer (r =0.407,P ＜ 0.05),TIMP-2 and PLT (r =0.484,P ＜0.01),TIMP-2 and PCT (r=-0.523,P＜0.01),TIMP-2 and DIC score (r=-0.579,P＜0.01).The areas under the curves (AUC) for TIMP-1/TIMP-2 was 0.896 (95％ CI:0.843 ～ 0.950 (P ＜ 0.05).Conclusions Serum levels of TIMP-1 in patients with severe sepsis complicated with DIC increased and TIMP-2 decreased,suggesting they were valuable in diagnosis of severe sepsis complicated with DIC.
